Should a Mental Illness Mean You Lose Your Kid?

Posted on May 30, 2014

In August 2009, Mindi, a 25-year-old struggling new parent, experienced what doctors later concluded was a psychotic episode. She had been staying in a cousin’s spare basement room in De Soto, Kansas, while trying get on her feet after an unexpected pregnancy and an abusive relationship. She’d been depressed since her daughter was born and was becoming increasingly distrustful of her relatives.

Isolated, broke and scared, one Saturday morning, she cracked. She woke to change her 5-month-old daughter’s diaper. When Mindi looked down, she believed the baby’s genitals had been torn.

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Mindi’s mind raced for an explanation. The one she came to? That her baby had been raped the night before; that someone—she did not know who—had put sedatives in the air vents.

Mindi called her pediatrician’s office. A receptionist told her to take her daughter to a children’s hospital in nearby in Kansas City, Missouri. Doctors there found no evidence that the girl had been harmed or that any of what Mindi claimed had actually happened.

After Mindi started arguing, medical staff sent her for a psychological evaluation and notified local child welfare authorities, according to court records. (As is typical in child welfare cases, the court documents do not include the full names of anybody in the family. Mindi has asked ProPublica to use only her first name, as did other parents in the story.)

That night, authorities took emergency custody of Mindi’s daughter, who is referred to in court documents by her initials, Q.A.H. A court-appointed doctor later concluded that Mindi had experienced postpartum psychosis.

But Mindi rebounded after the episode. She began to attend therapy and to see a psychiatrist, who prescribed an antidepressant. She found a job as a shift manager at Kmart and moved into her own apartment. Each morning, she’d call the foster home where her daughter had been placed and she’d read Q.A.H. a book.

In time, her psychiatrist, therapist and even a panel of judges concluded that Mindi should get her daughter back.

“I found the help I needed to be healthy,” says Mindi, a wide-eyed woman with a round face and a chatty affect. “I was dealing with some mental battles at the time.”

Dr. Stanley Golan, the psychiatrist who treated Mindi, diagnosed her with a mix of post-traumatic stress disorder—likely, a therapist later said, related to abuse—depression and possibly a kind of “mild delusional disorder.” Still, the diagnoses, Golan said in court testimony, “do not interfere with her parenting and she is able to adequately care for Q.A.H.”

“You can have these diagnoses and be symptom-free,” he testified.

Indeed, in September 2011, Mindi, who was in another relationship, gave birth again, to a boy named Jace, whom she’s now raising capably on her own. Citing Mindi’s pending case over Q.A.H., Kansas authorities took Jace at birth and placed him in foster care. But they soon returned him after finding no evidence that Mindi posed any risk to her son. As a family therapist testified, Mindi has provided a “nurturing, loving environment and had met all of [Jace’s] needs.”

Yet four years later, after a protracted series of court fights, Mindi does not have her daughter back.

“I couldn’t see how they could keep one while I had the other,” said Mindi, sitting on the carpet in a living room with her son, surrounded by toy trains and a pile of books. “I don’t think I should have to fight for my own child to come home.” (Missouri and county child welfare officials declined to discuss the case.)

The question in Mindi’s case is not about what authorities did when she plunged into a mental health crisis—nearly everyone involved in the case, including Mindi’s own attorneys, agrees it was likely appropriate to remove her baby that day. Instead, the issue is whether a mental health diagnosis itself, in the absence of any harm, should be enough to keep Mindi from ever getting her daughter back.

Under a concept sometimes called “predictive neglect,” Missouri and about 30 other states allow courts to terminate a parent’s connection to a child if authorities conclude a mother or father has a mental illness that renders them incapable of safely raising the child. Officials usually must present evidence that the illness poses a threat. Most cases involve significant mental illness, not run-of-the-mill depression or anxiety. Yet there need be no evidence of actual harm or neglect, just a conclusion that there is a risk of it.

States typically do not track how many parental termination cases are related to mental illness, or how often parents have lost children based on a diagnosis. New York, one of the few states that does tally such cases, has about 200 parental terminations annually based on mental disability, a category that includes both mental illness and “mental retardation.” If there were a similar rate nationally, that would amount to several thousand cases per year. The cases are typically sealed, and there’s no way to know how many involve court overreach.

But if it’s impossible to know how many parents lose children unnecessarily because of the stigma of mental illness, it’s clear that the process for deciding such cases is deeply flawed.

Courts’ decisions rest on the recommendations of evaluators who often do not observe parents at home or examine their actual record of parenting. Instead, they rely on psychological tests and case notes.

Incomplete evaluations are an “endemic problem,” said Joanne Nicholson, who directed a unit that conducted parenting assessments for Massachusetts child welfare agencies and is one the country’s leading researchers on parents with mental illness.

“Parents are often evaluated without a real analysis of their supports, of the life they actually live,” said Nicholson, currently a psychiatry professor at Dartmouth College. As a result, “the diagnosis starts to speak louder than real life.”

Children can also pay a price when courts overstep. Research shows that forcing children in and out of different homes can leave lasting emotional scars.

The logic of removing kids from parents with serious mental illness is straightforward. Studies have shown that serious mental illness correlates with higher rates of child neglect and abuse. Parents who can’t take care of themselves aren’t going to be in a position to take care of a child. And delusional thinking can lead to irrational, dangerous behavior.

“You have to put protection first,” said Mary Kay O’Malley, who worked for years as a foster care caseworker, is now a professor at the University of Missouri Law School and has dealt with many cases like Mindi’s.